NPIMap

Organization Active NPI

Xceptional Health & Wellness, PLLC.

  • Family Medicine Physician
  • Southaven, MS
National Provider Identifier
1770857443
Registry record updated Feb 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
XCEPTIONAL HEALTH & WELLNESS, PLLC.
Practice address
5779 Getwell Rd
BLDG. D, Suite 3
Southaven, MS 38672-6347
Phone
(662) 510-6507
Fax
(662) 510-6508
NPI assigned
Feb 28, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tracey F Petrides, MDNPI 1295927226
Title
Owner/MD
Phone
(662) 510-6507

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5779 Getwell Rd
BLDG. D, Suite 3
Southaven, MS 38672-6347

Mailing address

5779 Getwell Rd
BLDG. D, Suite 3
Southaven, MS 38672-6347
Phone (662) 510-6507

National Provider Directory

National Provider Directory

Locations

5779 Getwell Rd
Bldg D3
Southaven, MS 38672
Phone (662) 510-6507

5779 Getwell Rd
Ste 2
Southaven, MS 38672

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330387200000",
    "number": "1770857443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5779 GETWELL RD",
            "address_2": "BLDG. D, SUITE 3",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726347",
            "telephone_number": "662-510-6507",
            "fax_number": "662-510-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5779 GETWELL RD",
            "address_2": "BLDG. D, SUITE 3",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726347",
            "telephone_number": "662-510-6507",
            "fax_number": "662-510-6508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XCEPTIONAL HEALTH & WELLNESS, PLLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-28",
        "last_updated": "2012-02-28",
        "status": "A",
        "authorized_official_last_name": "PETRIDES",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "662-510-6507",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.